MAMMOGRAM

WHAT IS A MAMMOGRAM?

A mammogram uses a technique called mammography that is used to visualize normal and abnormal structures within the breasts. This is a low-dose x-ray test that generates images of the inner breast tissue on film. Therefore, a mammography identifies cysts, calcifications, and tumors within the breast. Currently, this is the most efficient screening method that detects early signs of breast cancer.

Additional to mammograms, doctors also recommend breast self-examination (BSE) on a monthly basis. However, unlike the mammography, physical examinations as BSE typically discover breast cancers at a much later stage.  Furthermore, since the changes (in shape or size of a breast, a lump, nipple discharge, or pain) detected by one’s BSE exam may happen monthly due to women’s menstrual periods, only doctors can know for certain whether they are indeed the signs for cancer. As such, a mammogram allows doctors to have a closer look for breast tissue changes not felt during a breast exam. Hence, women who have no breast complaints and who have breast symptoms should use mammograms.

Overall, it is essential for a woman to perform the monthly BSE and take a breast examination by her doctor in addition to the mammogram for the most effective screen for breast cancer. The American Cancer Society suggests that women take her first baseline mammogram in the ages between 35 and 40. After the age of 40, experts recommend a yearly mammogram.

Recently, there are two additional advances in mammography: digital mammography and computer-aided detection.

1)      Digital mammography, also called full-field digital mammography (FFDM), is a mammography system that utilizes solid-state detectors instead of x-ray films. These detectors convert x-rays into electrical signals similar to those found on digital cameras. Then, these electrical signals produce images of the breast seen on a computer screen or printed on special film. From the patient’s perspective, taking a digital mammogram is essentially the same as taking a conventional film mammogram.

2)      Computer-aided detection (CAD) is a system that utilizes digitized mammographic image obtained from a conventional film mammogram or a digitally acquired mammogram. Then, the computer software finds abnormal areas of density, calcification, or mass, which is a possible indication of cancer. These areas are then highlighted by the CAD system to alert the radiologist for further analysis.

 WHAT HAPPENS DURING A MAMMOGRAPHY? 

Mammogram utilizes x-rays to generate images of the inner breast tissue on film. Like light or radio waves, x-rays are forms of radiation that passes through the body. Hence, once the area of the body being examined is carefully positioned, an x-ray machine produces radiation that passes through the body, recording an image on photographic film or on a special digital image recording plate. On the x-ray pictures, shades of gray represent soft tissues (muscle, fat, organs) which allow more of the x-rays to pass through. White areas indicate bones as they are dense and absorb much of the radiation. Finally, black represents air. Today, most images are digital files stored electronically.

 Prior to the actual screening, a brief medical history and a history of specific problems related to the breast are obtained. Specific problems may include pain or a palpable lump that is felt. Then, a small x-ray marker may be taped on the breast overlying the palpable lump to help determine the need for other special mammogram views beyond the standard views. Additionally, before the exam, all jewelry and clothing in the chest and breast area are removed.

 To begin the exam, you first stand in front of a special x-ray machine. The Radiologic technician, who takes the x-rays, positions your breast between an x-ray panel and a plastic panel, one at a time. Attached to the x-ray machines, these plates compress the breasts to spread the breast tissue out for clearer pictures. If compression is not used, the mammograms may appear blurry, breast tissue may not be properly outlined, and small lesions can be overlooked. As a result, the pressure may cause discomfort, but will only last for a few seconds. Often times, two images will be taken of each breast: one from the side and one from above. In total, a screening mammogram takes approximately 20 minutes to finish.

 After the x-ray pictures are taken, the images are further developed and examined by a radiologist who specializes in x-ray and other imaging interpretations.

 WHAT SHOULD I DO TO PREPARE FOR A MAMMOGRAM?

 Before scheduling a mammogram, the American Cancer Society (ACS) and other specialty organizations suggest that you discuss any new findings or problems in your breast with your doctor. Additionally, notify your doctors of any prior surgeries, hormone use, and family or personal history of breast cancer.

 Prior to the exam, please check with the place you are having the mammogram for any special instructions. Below are some general guidelines to prepare:

  • Avoid making a mammogram appointment during the week before your menstrual period. After this period, your breasts will be less tender and swollen. Thus, mammograms will hurt less and generate better images.
  • Always notify your doctor or the x-ray technologists if you are pregnant or suspecting pregnancy.
  • Inform your mammography facility if you have breast implants.
  • Wear a shirt with shorts, pants, or a skirt.
  • On the day of your mammogram appointment, do not wear any deodorant, antiperspirants, perfume, lotion, or powder under your arms or on your breast. Antiperspirants can make images appear foggy, while powders can sometimes simulate the appearance of microcalcifications (an abnormal finding sometimes associated with breast cancer).
  • If you have had mammograms at other facilities, have those x-ray films sent to the new facility.
  • Ask when your results will be available.

 WHAT ARE THE RISKS? ARE THERE ANY AFTER EFFECTS?

 Because a mammogram is an x-ray test which uses radiation, there is some low risk of radiation exposure to the patients’ body. However, the amount of radiation exposed by a mammography is exceptionally low and is approved by national and international regulatory agencies (and also the National Department of Health and Human Services). Nevertheless, patients who are pregnant or suspecting pregnancy need to inform their requesting practitioner and radiology staff prior to the scan as radiation can pose a risk to the developing fetus.

Discomforts may exist from pressure felt on your breast as it is squeezed by the compression paddle. If so, schedule the examination when your breasts are least tender (avoid menstrual periods). Additionally, inform the technologist if you feel pain as the compression is increased. In such cases, less compression will be used.

 WHAT HAPPENS WITH THE MAMMOGRAM SCAN RESULTS?

The results of your mammogram will be given by either the radiologist at the completion of the mammogram or by the patient’s doctor who referred the mammogram. A radiologist is a physician specifically trained to supervise and interpret radiology examinations. In some cases, the radiologist will analyze the images and then send a signed report to your primary care or referring physicians. As such, your primary care or referring physicians will be the ones to discuss the results with you.

Sometimes, you may receive a card in the mail with the results of the mammogram. Generally, the report may take a few days to reach the referring doctor by mail. However, if a suspicious area is analyzed on the mammogram, this information will usually be relayed directly to the referring doctor by phone.

Note: The mammography facility should notify you of the results. Thus, if you have not received the notification or the results of a mammogram itself, you should call the doctor after a reasonable period of time. Do not assume the mammogram was normal if not received any type of notification of the result.

Often, follow-up examinations will be necessary. In such cases, your doctor will explain the exact reasons for requesting additional exams. Sometimes, the reasons may include: to clarify a suspicious or questionable finding, to detect over time any changes in a known abnormality, or to assess the stability or effectiveness of a treatment over time.

If your results turn out to be abnormal, do not panic. An abnormal mammogram does not mean you have cancer. A majority of abnormal mammograms are caused by benign (harmless) processes. Sometimes, it may just be an area of thicker or denser breast tissue, a cyst, or a harmless lump (fibroadenoma). When discovering a suspicious area, the patient may be advised to obtain further mammograms of that area, to have an ultrasound or other imaging exams of the breast, to see a breast disease specialist, or to have a biopsy of that suspicious area to remove a sample of breast tissue for laboratory testing. Some situations require the use of MRI in areas where the current imaging with mammography or ultrasound is negative and where the cause of a breast change or abnormality is not clear.

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